ICD-11 Classification Research Articles

Wernicke-Korsakoff syndrome in the new ICD-11 classification

Wernicke-Korsakoff syndrome in the new ICD-11 classification

Prevalence and structure of self-other problems in SAPAS screening for personality disorder in a National Sample.

This study investigated the prevalence and factorial structure of personality disorder features in the general community measured with the self-report form of the Standardized Assessment of Personality - Abbreviated Scale (SAPAS-SR). SAPAS-SR was administered to a Danish national community sample (N=50,326; 53% women). The hierarchical latent structure was examined using exploratory factor analyses (EFA) for one to three levels. We found that 11.3% of the community sample fulfilled the estimated screening criteria for a personality disorder, which was slightly higher for woman and younger people. As hypothesized, a two-factor model corresponded to aspects of self (e.g., being a worrier) and others (e.g., having difficulty making and keeping friends), whereas a three-factor model corresponded to trait domains of negative affectivity, detachment, and externalization. These findings suggest that personality disorder features play a significant role for at least one out of ten individuals in the Danish general community. Such features are primarily organized in a pattern of self- and interpersonal functioning, which is consistent with the conceptualization of core personality dysfunction in the DSM-5 Alternative Model of Personality Disorders and the ICD-11 Classification of Personality Disorders. © 2019 John Wiley & Sons, Ltd.

Field Testing of ICD-11 Proposals for Female Sexual Dysfunctions in India: Cognitive Interviews with Patients

Women's experiences of female sexual difficulties are shaped by cultural expectations. To investigate the cultural validity and clinical utility of the classification of female sexual dysfunctions (FSD) in the International Classification of Diseases - 11th Revision (ICD-11) among Indian Women. A purposive sample of 22 married women with probable sexual problems underwent cognitive interviews that were conducted using a semi-structured guide. The interviews were transcribed and analyzed qualitatively to help establish the content and cultural validity of the ICD-11 classification of FSD. Most participants had limited knowledge of the sexual act, felt unskilled in sex, and were led by their husbands in sexual matters. Many participants reported problems related to sexual dysfunction and sexual pain-penetration. Many participants with sexual pain-penetration issues and some with low sexual desire considered these symptoms to be problematic; however, this was rarely the case with the absence or lack of sexual arousal and orgasm. The application of the 'independent focus of clinical attention' requirement for diagnosis reduced cases by half for Hypoactive Sexual Desire Disorder (HSDD) and almost eliminated all cases of Female Sexual Arousal Dysfunction (FSAD) and Anorgasmia. Hence, this requirement was moved from essential (required) features to 'additional features' of the final ICD-11 sexual dysfunction guidelines. Advancement toward a more precise nomenclature and classification system of FSD will facilitate better diagnosis which will ultimately lead to improved care for women with sexual dysfunction.

Legal and Policy Implications in Mexico of Changes in ICD-11 Paraphilic Disorders

IntroductionThe World Health Organization (WHO) has made substantial changes to the classification of paraphilic disorders for the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), recently approved by the World Health Assembly. The most important is to limit paraphilic disorders primarily to persistent and intense patterns of atypical sexual arousal involving non-consenting individuals, manifested through persistent sexual thoughts, fantasies, urges, or behaviors, that have resulted in action or significant distress. AimTo analyze the legal, regulatory, and policy implications of the changes in the ICD-11 classification of paraphilic disorders for forensic practice, health systems, adjudication of sex offenders, and the provision of treatment in Mexico. MethodsAn expert Mexican advisory group was appointed to conduct this evaluation following an assessment guide provided by the WHO. Main Outcome MeasuresThe WHO assessment guide covered (i) laws related to sexual behaviors; (ii) the relationship between legal and clinical issues for non-forensic health professionals; (iii) implications of mental disorder classification for forensic practice; (iv) other implications of ICD-11 paraphilic disorders proposals; and (v) contextual issues. ResultsA variety of factors in Mexico make it highly unlikely that appropriate, evidence-based treatments for paraphilic disorders will be provided to those who need them, even if they seek treatment voluntarily and have not committed a crime. Mexican law focuses on the punishment of specific sexual behaviors rather than on underlying disorders. A paraphilic disorder would not be considered sufficient grounds for exemption from criminal responsibility. The application and scope of mental health evaluations in Mexican legal proceedings are quite limited, and individuals who commit sexual crimes almost never undergo forensic evaluations to establish the presence of paraphilic disorders. Psychiatric services may be mandated for sex offenders in highly specific circumstances but cannot exceed the duration of the criminal sentence. Clinical ImplicationsEvaluation and treatment guidelines should be developed based on international evidence and standards and promulgated for use with individuals with paraphilic disorders in forensic and non-forensic poopulations. The much greater specificity and operationalization of the ICD-11 guidelines as compared with the ICD-10 guidelines provide a better basis for identification and case formulation. Strengths & LimitationsMajor strengths of this analyses were that it was conducted to facilitate international comparability across several participating countries and the fact that it was conducted by a diverse multidisciplinary group representing various relevant legal, forensic and and clinical sectors. A limitation was that it was only possible to examine relevant federal laws and those of Mexico City rather than those of all 32 Mexican states. ConclusionThe descriptions of paraphilic disorders in the ICD-11 could support substantial improvements in the treatment of individuals with paraphilic disorders and the adjudication of sex offenders in Mexico, but specific changes in Mexican law would be required.Martínez-López JNI, Robles R, Fresán A, et al. Legal and Policy Implications in Mexico of Changes in ICD-11 Paraphilic Disorders. J Sex Med 2019;16:1623–1637.

Dissociative identity disorder needs re-examination

SUMMARYDissociative identity disorder (DID) is as real as any other psychiatric disorder but has been over-diagnosed by gullible clinicians, especially in forensic settings. Its classification has been poor, but the new ICD-11 classification, especially of partial DID, should help research and practice.DECLARATION OF INTERESTNone.

Problems with the ICD-11 classification of personality disorder

Problems with the ICD-11 classification of personality disorder

Mental health professionals' perceived clinical utility of the ICD-10 vs. ICD-11 classification of personality disorders.

The ICD-11 classification of personality disorders (PDs) has adopted a dimensional approach which includes three levels of severity (mild, moderate and severe) with the option of specifying five trait qualifiers (negative affectivity, detachment, dissociality, disinhibition and anankastia) and one borderline pattern qualifier. This study examined mental health professionals' perceived clinical utility of the ICD-11 PD framework compared with the ICD-10 categorical PD framework. A sample of 163 mental health professionals (primarily psychologists, nurses and medical doctors) completed a survey in which they were asked to apply the ICD-10 and ICD-11 PD classifications on one of their patients followed by judgement of their clinical utility. The ICD-11 PD framework was generally rated as being slightly more useful than the ICD-10 framework even when accounting for educational background and years of experience. This advantage particularly involved the utility for treatment planning, communicating with patients, comprehensiveness and ease of use. The two frameworks showed no significant differences with respect to utility for communicating with other professionals and describing global personality. This study provided initial evidence that mental health professionals perceive the ICD-11 PD classification as slightly more useful for clinical practice than the ICD-10 classification. © 2019 John Wiley & Sons, Ltd.

Highlights of ICD-11 Classification of Mental, Behavioral, and Neurodevelopmental Disorders

Highlights of ICD-11 Classification of Mental, Behavioral, and Neurodevelopmental Disorders

Ventricular septal defect associated with aortic valve prolapse: An echocardiographicstudy

Ventricular septal defects (VSD) can be associated with aortic valve prolapse (AVP) with or without regurgitation. Aortic valve prolapse may be due to both lack of leaflet support and Venturi's phenomenon. There is a great diversity in the literature about the anatomic type of the VSDs associated with AVP. The objective of the study was then to assess the anatomy of the VSD on echocardiography. From 2009 to 2017, 51 consecutive patients with VSD complicated by AVP were admitted for surgery. We screened retrospectively all preoperative echocardiographies in double-blind test. We analyzed the anatomic type of the VSD according to ICD-11 classification and looked for outlet septum malalignment, the nature of the prolapsed aortic leaflet, the severity of aortic regurgitation and other complications. The VSD was central perimembranous (pm) in 23 patients (45%), outlet with malalignment in 21 (41%) and outlet juxta-arterial in 7 (13.7%). We found a significant difference between the initial diagnosis and the final one after reviewing echography in double-blind test: among the 23 VSD initially described as central pm, eleven were reclassified as outlet VSD, and one outlet VSD was reclassified as central pm ( P < 0.001). Aortic valve prolapse involved the right aortic cusp in 98% of patients. Aortic regurgitation was severe in 2 patients, moderate in 5, mild in 24 and trivial or absent in 20. Outlet VSDs were significantly more often associated with aortic regurgitation ( P = 0.036). Subaortic membrane was found in 8 patients (15.6%), 6 with outlet and 2 with central pm VSD ( P < 0.001). Right ventricular obstruction was found in 8 patients (15.6%). Aortic valve prolapse complicates indifferently central pm and outlet VSD. However, aortic insufficiency is more frequent in outlet VSD. The accurate echocardiographic diagnosis of the anatomic type of the VSD is difficult and multiple views are necessary.

The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics.

The nomenclature of personality disorders in the 11th revision of the International Classification of Diseases and Related Health Problems represents the most radical change in the classification history of personality disorders. A dimensional structure now replaces categorical description. It was argued by the Working Group that only a dimensional system was consistent with the empirical evidence and, in the spirit of clinical utility, the new system is based on two steps. The first step is to assign one of five levels of severity, and the second step is to assign up to five prominent domain traits. There was resistance to this structure from those who feel that categorical diagnosis, particularly of borderline personality disorder, should be retained. After lengthy discussion, described in detail here, there is now an option for a borderline pattern descriptor to be selected as a diagnostic option after severity has been determined.

Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders.

Following approval of the ICD-11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transitionfrom the ICD-10 to the ICD-11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders following ICD-11's approval. The development of the ICD-11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD-11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture-related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery-based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, and the development of two new ICD-11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD-11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD-11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.

The IASP classification of chronic pain for ICD-11: chronic secondary musculoskeletal pain.

Chronic musculoskeletal pain is defined as chronic pain arising from musculoskeletal structures such as bones or joints. Although comprising the most prevalent set of chronic pain conditions, it was not represented appropriately in the 10th edition of the International Classification of Diseases (ICD-10), which was organized mainly according to anatomical sites, was strongly focused on musculoskeletal disease or local damage, and did not consider the underlying mechanisms of pain. The new ICD-11 classification introduces the concept of chronic primary and secondary musculoskeletal pain, and integrates the biomedical axis with the psychological and social axes that comprise the complex experience of chronic musculoskeletal pain. Chronic primary musculoskeletal pain is a condition in its own right, not better accounted for by a specific classified disease. Chronic secondary musculoskeletal pain is a symptom that arises from an underlying disease classified elsewhere. Such secondary musculoskeletal pain originates in persistent nociception in musculoskeletal structures from local or systemic etiologies, or it may be related to deep somatic lesions. It can be caused by inflammation, by structural changes, or by biomechanical consequences of diseases of the nervous system. It is intended that this new classification will facilitate access to patient-centered multimodal pain management and promote research through more accurate epidemiological analyses.

Ventricular septal defect associated with aortic valve prolapse: An echocardiographic study

Ventricular septal defects (VSD) can be associated with aortic valve prolapse (AVP) with or without regurgitation. Aortic valve prolapse may be due to both lack of leaflet support and Venturi's phenomenon. There is a great diversity in the literature about the anatomic type of the VSDs associated with AVP. The objective of the study was then to assess the anatomy of the VSD on echocardiography. From 2009 to 2017, 51 consecutive patients with VSD complicated by AVP were admitted for surgery. We screened retrospectively all preoperative echocardiographies in double-blind test. We analyzed the anatomic type of the VSD according to ICD-11 classification and looked for outlet septum malalignment, the nature of the prolapsed aortic leaflet, the severity of aortic regurgitation and other complications (subaortic membrane, right ventricular stenosis). The VSD was central perimembranous (pm) in 23 patients (45%), outlet with malalignment in 21 (41%) and outlet juxta-arterial in 7 (13.7%). We found a significant difference between the initial diagnosis and the final one after reviewing echography in double-blind test: among the 23VSD initially described as central pm, eleven were reclassified as outlet VSD, and one outlet VSD was reclassified as central pm ( P < 0.001). Aortic valve prolapse involved the right aortic cusp in 98% of patients. Aortic regurgitation was severe in 2 patients, moderate in 5, mild in 24 and trivial or absent in 20. Outlet VSDs were significantly more often associated with aortic regurgitation ( P = 0.036). Subaortic membrane was found in 8 patients (15.6%), 6 with outlet and 2withcentral pm VSD ( P < 0.001). Right ventricular obstruction was found in 8 patients (15.6%). Aortic valve prolapse complicates indifferently central pm and outlet VSD. However, aortic insufficiency is more frequent in outlet VSD. The accurate echocardiographic diagnosis of the anatomic type of the VSD is difficult and multiple views are necessary.

Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys.

The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. Cross-sectional household surveys. Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5-22.6%) and 7.0% (6.4-7.7%), respectively. Among cannabis users, 9.3% (7.4-11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3-4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ≥0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems. The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported 'harm to others' is questionable.

Application of the ICD-11 classification of personality disorders

BackgroundThe ICD-11 classification of Personality Disorders focuses on core personality dysfunction, while allowing the practitioner to classify three levels of severity (Mild Personality Disorder, Moderate Personality Disorder, and Severe Personality Disorder) and the option of specifying one or more prominent trait domain qualifiers (Negative Affectivity, Detachment, Disinhibition, Dissociality, and Anankastia). Additionally, the practitioner is also allowed to specify a Borderline Pattern qualifier. This article presents how the ICD-11 Personality Disorder classification may be applied in clinical practice using five brief cases.Case presentation(1) a 29-year-old woman with Severe Personality Disorder, Borderline Pattern, and prominent traits of Negative Affectivity, Disinhibition, and Dissociality; (2) a 36-year-old man with Mild Personality Disorder, and prominent traits of Negative Affectivity and Detachment; (3) a 26-year-old man with Severe Personality Disorder, and prominent traits of Dissociality, Disinhibition, and Detachment; (4) a 19-year-old woman with Personality Difficulty, and prominent traits of Negative Affectivity and Anankastia; (5) a 53-year-old man with Moderate Personality Disorder, and prominent traits of Anankastia and Dissociality.ConclusionsThe ICD-11 Personality Disorder classification was applicable to five clinical cases, which were classified according to Personaity Disorder severity and trait domain qualifiers. We propose that the classification of severity may help inform clinical prognosis and intensity of treatment, whereas the coding of trait qualifiers may help inform the focus and style of treatment. Empirical investigation of such important aspects of clinical utility are warranted.

Experiences with Coding using ICD-11: “The Codes Paint a Clearer Picture”

IntroductionA high performing health data classification system requires clear, comprehensive code descriptions and user-friendly coding tools for effective coding. Coding specialists have essential specialized knowledge to contribute to the development and functionality of the 11th version of International Classification of Diseases (ICD-11) that will be released in June of 2018.&#x0D; Objectives and ApproachThe objective was to evaluate coding specialists’ experience of coding using ICD-11 for complete inpatient hospital charts. Mixed methods were employed for a survey and interviews. As part of a large field trial, 6 certified coding specialists underwent training to use the ICD-11 Beta Draft browser and ICD-11 Coding Tool. The coding team completed multiple coding exercises and coded over 60 charts each prior to evaluation of their experience. An electronic survey was used to evaluate ICD-11 knowledge, comprehension, and application of the coding training. Interviews explored the coders’ experience of learning and using the ICD-11 classification system.&#x0D; ResultsThe coding team (3 to 10 years of experience) received 14 hours classroom training and 5-10 hours per week of coding practice over 3 months. After training, perceived confidence in coding with ICD-11 was satisfactory; moderate (n=4), high (n=1), and low (n=1). Coding short scenarios was the most useful resource (n=6) and lack of guidelines was the most frustrating. Learning ICD-11 was deemed moderately (n=2) to somewhat (n=3) difficult but each coder described satisfaction in learning the new system. From the interviews, coders expressed liking the ability to more fully describe health conditions and hospital harms with code clusters. “The codes paint a clearer picture of what happened than with ICD-10”. With practice they achieved speed with the coding tools.&#x0D; Conclusion/ImplicationsCoding specialists learned and proficiently used the Beta Version of ICD-11 coding system with moderate perceived confidence. New ICD-11 codes and clustering functions allowed for more complete description of health scenarios and enhanced coder satisfaction.

Ventricular septal defect associated with aortic valve prolapse: An echocardiographic study

Objectives Ventricular septal defects (VSD) can be associated with aortic valve prolapse (AVP) with or without regurgitation. Aortic valve prolapse may be due to both lack of leaflet support and Venturi's phenomenon. There is a great diversity in the literature about the anatomic type of the VSDs associated with AVP. The objective of the study was then to assess the anatomy of the VSD on echocardiography. Methods From 2009 to 2017, 51 consecutive patients with VSD complicated by AVP were admitted for surgery. We screened retrospectively all preoperative echocardiographies in double-blind test. We analyzed the anatomic type of the VSD according to ICD-11 classification and looked for outlet septum malalignment, the nature of the prolapsed aortic leaflet, the severity of aortic regurgitation and other complications (subaortic membrane, right ventricular stenosis). Results The VSD was central perimembranous (PM) in 23 patients (45%), outlet with malalignment in 21 (41%) and outlet juxta-arterial in 7 (13.7%). We found a significant difference between the initial diagnosis and the final one after reviewing echography in double-blind test: among the 23VSD initially described as central PM, eleven were reclassified as outlet VSD, and one outlet VSD was reclassified as central PM (P Conclusion Aortic valve prolapse complicates indifferently central PM and outlet VSD. However, aortic insufficiency is more frequent in outlet VSD. The accurate echocardiographic diagnosis of the anatomic type of the VSD is difficult and multiple views are necessary.

The impact of gender on the factor structure of PTSD symptoms among active duty United States military personnel

ObjectivesGender has increasingly been looked at as an important variable in psychological research. Posttraumatic Stress Disorder (PTSD) has long been recognized to have a greater incidence of occurrence in women than men. Factor analytic studies have generally supported the presence of a 4 factor model, although confirmatory factor analysis has acknowledged the influence of factor invariance. Recent studies have found wide variety in the symptom endorsement within samples of individuals diagnosed with PTSD. Invariance of PTSD factor structure across groups holds significant importance in terms of understanding underlying variation in factor structures as a function of type of traumas or gender. This study examined the impact of gender on PTSD factor structure. MethodsSubjects (n=16,146) were active duty military personnel who completed the 2005 Department of Defense (DoD) Survey of Health Related Behaviors Among Active Duty Military Personnel (HRB). The study sample for this analysis included results from men (n=12,119) and women (n=4027) active duty military personnel over the age 18years who completed the HRB survey. Participants averaged M=31.3, SD=8.6years of age. ResultsResults found a four-factor solution fit best for both the group as a whole, and for men and women military personnel. However, the nature of the factors varied when gender was examined. ConclusionThe findings support how PTSD may present differently in men and women, and the need for examination of possible differing experiences of PTSD in populations of trauma survivors. The DSM-5 and potential changes in ICD-11 classifications increase the importance of how gender differences might be evidenced, and in how post trauma schema is manifested when gender is a consideration.

Aligning the ICD-11 classification of disorders due to substance use with global service needs.

The use of psychoactive, potentially dependence-producing substances is highly prevalent around the world, and contributes substantially to global disease burden. There is a major gap between the need for treatment for substance use disorders. Changes proposed for the classification of substance use disorders in the Eleventh Revision of the International Classification of Diseases and Related Health Problems, based on a public health approach, have important implications for the conceptualisation, structure and availability of services. These include: (1) an updated and expanded range of substance classes; (2) greater specification of different harmful patterns of substance use, which may be continuous or episodic and recurrent; (3) a new category to denote single episodes of harmful use; (4) a category describing hazardous use of substances; and (5) simplification of diagnostic guidelines for substance dependence. This paper describes these changes and the opportunities they present for improved prevention, treatment, monitoring and health policy.

Przyczyny zgonów dzieci i młodzieży w wieku 1-19 lat w Polsce w świetle międzynarodowych statystyk od 2000 roku.

BackgroundAnalyses of children and young people mortality continue to be an important component of health monitoring of this population. Such analyses provide the basis to assess the overall trends, the structure of the causes of death over longer periods, and the differences between Poland and other countries.PurposeThe purpose of the current study is to present the current status and the direction of changes since 2000 with regard to the level and underlying causes of mortality in children and adolescents aged 1-19 years in Poland on the background of statistics for leading European countries.Material and methodsInteractive databases available online: the National Demographic Database provided by the Central Statistical Office and the International WHO-MDB Database were used. Poland, constantly belonging to Eur-B category, was compared with the combined group of 27 leading countries, classified as a very low total mortality group (Eur-A) according to WHO. Linear trends of overall and cause-specific mortality in 2000–2013 were estimated. The causes of death have been presented according to the main classes of the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). External and other causes were adopted as the two principal categories.ResultsIn 2015, 1471 deaths of persons aged 1-19 were recorded in Poland (19.9 per 100 000, 25.4 and 14.2 for boys and girls, respectively). Changes in children and adolescents mortality by age have a nonlinear nature (U-shaped), and the lowest level is recorded at the age of 5-9 years.According to 2014 data, 50.2% of deaths of children and adolescents aged 1-19 years occurred due to external causes, including non-intentional and intentional ones. This percentage increased from 18.4% in the 1-4 age group to 68.6% at the age of 15-19 years. Apart from external causes, the dominating causes of death are malignant neoplasms, congenital defects, or nervous system and respiratory system diseases. The ranking of those causes of death changes in successive age groups and over time. When age is considered, a higher proportion of congenital defects and respiratory system diseases was found in mortality younger children and a higher proportion of circulatory system diseases and undefined cases in mortality of adolescents. When trends were studied, a continuing elimination of infectious diseases was observed together with growing impact of rare diseases in all age groups.The excess mortality of Polish population at age 1-19 by comparison to Eur-A countries increased from 21% in 2000 to 56% in 2013, mainly due to unfavourable trends in adolescents. The rate of decline in the mortality of young children (1-4 years) was greater than in Eur-A countries, both in case of external and other causes. In the age group 5-14 years the higher rate of change was sustained only with regard to external causes. Among adolescents and young adults, the distance between Poland and Eur-A countries increased during the studied period. The shape of trend in the 15-24 age group was unfavourable for Poland, mainly with respect to external causes. This observation could be in part explained by increasing suicide trend in Poland since 2008, coexisting with rather constant level in Eur-A countries.ConclusionsThe mortality rate among the population aged 1-19 years in Poland is systematically decreasing, but it still exceeds the average level recorded in leading European countries, particularly in relation to adolescents. When assessing the ability to reduce mortality in Poland to the level of Eur-A countries, attention must be paid to the causes considered as avoidable. Further studies ought to focus on the trends and international comparisons only foreshadowed in this study with regard to individual diagnoses, discussing possible preventive measures. Introduction of an ICD-11 classification will enable more accurate coding of causes of death, including a more precise analysis of the burden of rare diseases, which are an increasing challenge to public health in the population at the developmental age.